Provider Demographics
NPI:1902888456
Name:LOWE, CLAYTON DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:DAVID
Last Name:LOWE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12304 N. MAY AVE
Mailing Address - Street 2:
Mailing Address - City:WINTERSET
Mailing Address - State:OK
Mailing Address - Zip Code:50273
Mailing Address - Country:US
Mailing Address - Phone:405-669-3415
Mailing Address - Fax:
Practice Address - Street 1:12304 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1944
Practice Address - Country:US
Practice Address - Phone:405-669-3415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4623111N00000X
IAA06193111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1229393Medicaid
48282OtherBC/BS
U73863Medicare UPIN
IA1229393Medicaid